This proposal for a K24 Award is to support the applicant's career in patient-oriented research, mentoring of beginning clinical investigators, and career development. The long-term research goal of the applicant is to lead an NINDS funded Phase III clinical trial comparing intracranial stenting (using a drug-eluting stent) with best medical therapy in patients with symptomatic intracranial arterial stenosis. To accomplish this, the results of the recently completed NINDS funded Warfarin Aspirin Symptomatic Intracranial Disease (WASID) trial (which the applicant led), coupled with the results of studies in this proposal, will be used to design the Phase III trial. The Specific Aims of the research in this proposal are 1) to determine the 30-day, 1- year, and 2-year rates of stroke following intracranial stenting in a new prospective cohort of patients at high risk of stroke in the territory of the stenotic intracranial artery; 2) to establish the minimal benefit of stenting over medical therapy that physicians would require for stenting to become the treatment of choice; 3) to design a Phase I trial in patients with symptomatic intracranial arterial stenosis that will determine the safety of intracranial stenting (with a drug-eluting stent) and the 6 month re-stenosis rate; and 4) to determine optimal risk factor management in patients with intracranial stenosis. The mentoring responsibilities of the applicant will focus on developing the careers of stroke fellows and junior faculty in the multidisciplinary Emory Stroke Center who are committed to careers in patient-oriented research. This mentoring will include developing educational and research curricula for the trainees, helping trainees design research protocols and write grant applications, and assisting trainees with data analysis, writing of manuscripts and assembling a teaching portfolio. Career development of the applicant will involve taking course work in the analytic sciences at the Emory School of Public Health. This will further the applicant's career as a clinical trial list and make him a more effective mentor. The K24 Award will provide the applicant with the necessary protected time for this period of intensive focus on research and mentoring. This will help him achieve his career goals of making important contributions to the field of stroke therapeutics and training the next generation of patient-oriented stroke investigators.